The Effectiveness of the BITSEA as a Tool to Early Detect Psychosocial Problems in Toddlers, a Cluster Randomized Trial

Ingrid Kruizinga; Wilma Jansen; Nicolien C van Sprang; Alice S Carter; Hein Raat

doi:10.1371/journal.pone.0136488

The Effectiveness of the BITSEA as a Tool to Early Detect Psychosocial Problems in Toddlers, a Cluster Randomized Trial

PLoS One. 2015 Sep 18;10(9):e0136488. doi: 10.1371/journal.pone.0136488. eCollection 2015.

Authors

Ingrid Kruizinga¹, Wilma Jansen², Nicolien C van Sprang³, Alice S Carter⁴, Hein Raat¹

Affiliations

¹ Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
² Department of Youth Policy, Rotterdam Municipal Health Service (GGD Rotterdam- Rijnmond), Rotterdam, the Netherlands.
³ Public Health Care for Youth Rijnmond, Rotterdam, The Netherlands.
⁴ Department of Psychology, University of Massachusetts Boston, Boston, United States of America.

Abstract

Objective: Effective early detection tools are needed in child health care to detect psychosocial problems among young children. This study aimed to evaluate the effectiveness of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), in reducing psychosocial problems at one year follow-up, compared to care as usual.

Method: Well-child centers in Rotterdam, the Netherlands, were allocated in a cluster randomized controlled trial to the intervention condition (BITSEA--15 centers), or to the control condition ('care-as-usual'- 16 centers). Parents of 2610 2-year-old children (1,207 intervention; 1,403 control) provided informed consent and completed the baseline and 1-year follow-up questionnaire. Multilevel regression analyses were used to evaluate the effect of condition on psychosocial problems and health related quality of life (i.e. respectively Child Behavior Checklist and Infant-Toddler Quality of Life). The number of (pursuits of) referrals and acceptability of the BITSEA were also evaluated.

Results: Children in the intervention condition scored more favourably on the CBCL at follow-up than children in the control condition: B = -2.43 (95% confidence interval [95%CI] = -3.53; -1.33 p<0.001). There were no differences between conditions regarding ITQOL. Child health professionals reported referring fewer children in the intervention condition (n = 56, 5.7%), compared to the control condition (n = 95, 7.9%; p<0.05). There was no intervention effect on parents' reported number of referrals pursued. It took less time to complete (parents) or work with (child health professional) the BITSEA, compared to care as usual. In the control condition, 84.2% of the parents felt (very) well prepared for the well-child visit, compared to 77.9% in the intervention condition (p<0.001).

Conclusion: The results support the use of the BITSEA as a tool for child health professionals in the early detection of psychosocial problems in 2-year-olds. We recommend future studies in large and varied populations to replicate these findings.

Trial registration: Current Controlled Trials NTR2035.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Child Behavior Disorders / diagnosis*
Child Behavior Disorders / psychology
Child, Preschool
Early Diagnosis
Female
Humans
Infant
Male
Quality of Life / psychology*

Associated data

NTR/NTR2035

Grants and funding

This study is funded by a grant from the funding body ZonMw, the Netherlands Organization for Health Research and Development (project number: 80-82435-98-8058). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.